1)Join bed side teaching with year 5 USM students at Wad 2 Akik.
Topics:Gestational Diabetes Mellitus on Insulin.
-one student presented the cases (Complete clerking until physical examination)
-After finished presenting the cases, Dr Haji discussed with the students about the important points regarding the disease in which the patient had.
-noted with HO Ampang Guide.
2) Follow one dearest MO .
-She taught us about how to plot partogram (what details need to be write in the partogram chart) and how to read CTG.
-She explained to us about the ward work.
-Must study MgSO4 preparation (different hospital, different MgSo4 preparation)
-Told us to observe delivery first then try to conduct the delivery.
-Her advise : "Learn as many as possible during Hoship. It is okay to feel "bodoh" as long as we are always willing to learn. Management can learn later when we are treating the cases".
Partogram
3)In labor room:-Observe Dr do the episiotomy and vaginal examination to detect opening of the Os.
-Helping Dr and fellow nurses to prepare pt after delivery.
: putting pad on the patient, tie the pad.
:check the placenta before putting into the paper bag to bring back home.
4) Join medical ward oncall at 7 Utara ward with my secondary school senior Dr Afham .
-He taught us about how to put on branula and taking blood (VBG & ABG)
-Managed to draw blood on 2 patients on myself.
-He guided us on how to proper clerking pt in medical department. ( must tally and make reference on doctor in ED clerking the cases because most patient come to Medical ward are from ED) .
-Another Ho, Dr Farhana taught us how to key in data about blood investigation to send to the laboratory after filling the blood into the respective blood tubes.
[TAKE HOME MESSAGE DURING ONCALL MEDICAL WARD]
a) First call ward round malam untuk patient ada issues sahaja
b) MO di ED clerk case yang sampai ke ED terlebih dahulu then HO Medical clerk once again when patient entering the medical ward.
c) Common reason for haemodialysis in medical ward are:
- metabolic acidosis
-hyperkalaemia
-uremic symptom
-infection
d) When HO clerks the cases from ED :
- refer kertas kuning dan merah (clerking sheets) from ED
- Ix yang dah dibuat, refer and trace the result into observation charts.
e) For ABG result , important markers to be noted are ph , pCo2, lactate and bicarbonate.
f) Tips for blood taking (Branula insertion, ABG, VBG)
-Bila ambil darah, jangan inject di tempat yang ada edema or swelling.
-In ABG procedure,ambil dekat radial artery. Elakkan ambil di branchial artery sebab that area cuma ada satu artery.
-After done taking ABG, must compress at least 1min at injection site to avoid haematoma. (if any problem when doing ABG, might be a reason for extension in medical ward for 1 month)
-In CKD patient, usually difficult to take blood because most veins are collapsed.
-Tips inserting branula, masukkan only 1/4 of length of needle and adjust the needle tilll succeed.
Trolley for blood taking
Each blood taken must put in the respective plastic with label with corrrect patients' name.
Key in data for blood taking to be sent to each related laboratory.
3.30 am after night oncall at medical ward.
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